Epilepsy, which affects several hundred thousand British people today, is a disability.
Characterised by repetitive and chronic epileptics fits, in its severe form, things become a little more complicated. The patient is then considered to have a long-term disability and must be cared for.
Diagnosing a severe epilepsy
Several criteria can determine if a patient suffers from a severe epilepsy:
- Cognitive, psycho-affective, family, educational, school or professional repercussions of the disease;
- The frequency, nature and resistance to the treatment of the crises;
- Undesirable effects of the treatment.
Various means to establish an initial evaluation:
- Orientation and antecedents factors
- Age of first fits, patient's medical and family history
- Interrogation of the patient
- Description of the fits ("short, stereotyped and repetitive symptoms must draw the attention");
- Former neurological episode
- Starting factors
- Frequency and schedule of the crises
- Neurological examination (neuropsychologist)
- Different EEG (nap, ambulatory, night...)
- MRI, SPECT, TEP...
- Metabolic and genetic examinations (in the child)
- Neuropsychological assessment (psychological)
Once the diagnosis is established, by a neuro-paediatrician or a neurologist, the patient must be cared for. This consists in the following:
- A antiepileptic treatment
- Pharmacological treatment for a fit with loss of consciousness: recovery position + benzodiazepine by rectal or oral way when the crisis lasts more than 3 minutes, young subjects only.
- Basic pharmacological treatment: antiepileptic associated, depending on certain syndromes, with corticoids or piracetam.
- Other treatments
- Ketogenetic diet (diet based on fat, low in proteins and carbohydrate which is recognised as being anticonvulsive; requires hospitalisation)
- Treating complications
- Anxio-depressive, behaviour disorders: antidepressants, neuroleptics
- Vitamin therapy (vitamin D)
- Contraception for adolescents and women (recommended)
- Folic acid (pregnancy)
- Help in rehabilitation (family, social...)
- Detection of and dealing with co-morbidities and complications
- Help to improve quality of life
Therapeutic information must be combined with pharmacological treatment. The patient will:
- Be informed about the existence of epileptic people associations;
- Understand his disease;
- Be informed on his disease, treatments and their consequences;
- Adopt a healthy lifestyle (reduce or stop drinking alcohol);
- Plan consultations;
- Know the inherent risks of pregnancy and be informed on contraception, for adolescents and women.
The follow-up of patients affected by severe epilepsy is advised:
- To prevent spontaneous or iatrogenic complications;
- To supervise and adapt the treatment;
- To help professional, social or school rehabilitation;
- To accompany the patient and his entourage (therapeutic information...);
- To ensure the transition between dealing with a child suffering from a severe epilepsy to dealing with him as an adult.
The follow-up is clinical - to detect the undesirable effects of the treatment, to prevent pregnancy... - and paraclinical (biological examinations, MRI, EEG...).
To download a number of patient guides on severe epilepsy.
Photographic copyright: © OOZ - Fotolia.com
Prise en charge des épilepsies graves (HAS)